Anna Dalal Kirsch1, Sharon Hassin-Baer2, Cordula Matthies3, Jens Volkmann1, Frank Steigerwald4. 1. Department of Neurology, University-Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany. 2. Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer 5262101, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel. 3. Department of Neurosurgery, University-Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany. 4. Department of Neurology, University-Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany. Electronic address: Steigerwal_F@ukw.de.
Abstract
INTRODUCTION: Stimulation settings of deep brain stimulation (DBS) have evolved empirically within a limited parameter space dictated by first generation devices. There is a need for controlled clinical studies, which evaluate efficacy and safety of established programming practice against novel programming options provided by modern neurostimulation devices. METHODS: Here, we tested a polarity reversal from conventional monopolar cathodic to anodic stimulation in an acute double-blind, randomized, cross-over study in patients with PD implanted with bilateral STN DBS. The primary outcome measure was the difference between efficacy and side-effect thresholds (current amplitude, mA) in a monopolar review and the severity of motor symptoms (as assessed by MDS-UPDRS III ratings) after 30 min of continuous stimulation in the medication off-state. RESULTS: Effect and side effect thresholds were significantly higher with anodic compared to cathodic stimulation (3.36 ± 1.58 mA vs. 1.99 ± 1.37 mA; 6.05 ± 1.52 mA vs. 4.15 ± 1.13 mA; both p < 0.0001). However, using a predefined amplitude of 0.5 mA below the respective adverse effect threshold, blinded MDS-UPDRS-III-ratings were significantly lower with anodic stimulation (anodic: median 17 [min: 12, max: 25]; cathodic: 23 [12, 37]; p < 0.005). CONCLUSION: Effective anodic stimulation requires a higher charge injection into the tissue, but may provide a better reduction of off-period motor symptoms within the individual therapeutic window. Therefore, a programming change to anodic stimulation may be considered in patients suffering from residual off-period motor symptoms of PD despite reaching the adverse effect threshold of cathodic stimulation in the subthalamic nucleus.
RCT Entities:
INTRODUCTION: Stimulation settings of deep brain stimulation (DBS) have evolved empirically within a limited parameter space dictated by first generation devices. There is a need for controlled clinical studies, which evaluate efficacy and safety of established programming practice against novel programming options provided by modern neurostimulation devices. METHODS: Here, we tested a polarity reversal from conventional monopolar cathodic to anodic stimulation in an acute double-blind, randomized, cross-over study in patients with PD implanted with bilateral STN DBS. The primary outcome measure was the difference between efficacy and side-effect thresholds (current amplitude, mA) in a monopolar review and the severity of motor symptoms (as assessed by MDS-UPDRS III ratings) after 30 min of continuous stimulation in the medication off-state. RESULTS: Effect and side effect thresholds were significantly higher with anodic compared to cathodic stimulation (3.36 ± 1.58 mA vs. 1.99 ± 1.37 mA; 6.05 ± 1.52 mA vs. 4.15 ± 1.13 mA; both p < 0.0001). However, using a predefined amplitude of 0.5 mA below the respective adverse effect threshold, blinded MDS-UPDRS-III-ratings were significantly lower with anodic stimulation (anodic: median 17 [min: 12, max: 25]; cathodic: 23 [12, 37]; p < 0.005). CONCLUSION: Effective anodic stimulation requires a higher charge injection into the tissue, but may provide a better reduction of off-period motor symptoms within the individual therapeutic window. Therefore, a programming change to anodic stimulation may be considered in patients suffering from residual off-period motor symptoms of PD despite reaching the adverse effect threshold of cathodic stimulation in the subthalamic nucleus.
Authors: Johannes Vorwerk; Andrea A Brock; Daria N Anderson; John D Rolston; Christopher R Butson Journal: J Neural Eng Date: 2019-11-06 Impact factor: 5.379
Authors: Zachary T Irwin; Mohammad Z Awad; Christopher L Gonzalez; Arie Nakhmani; J Nicole Bentley; Thomas A Moore; Kenneth G Smithson; Barton L Guthrie; Harrison C Walker Journal: Clin Neurophysiol Date: 2020-03-12 Impact factor: 3.708
Authors: Daria Nesterovich Anderson; Gordon Duffley; Johannes Vorwerk; Alan D Dorval; Christopher R Butson Journal: J Neural Eng Date: 2018-10-02 Impact factor: 5.379
Authors: Daria Nesterovich Anderson; Alan D Dorval; John D Rolston; Stefan M Pulst; Collin J Anderson Journal: J Neural Eng Date: 2021-04-06 Impact factor: 5.379
Authors: Joachim K Krauss; Nir Lipsman; Tipu Aziz; Alexandre Boutet; Peter Brown; Jin Woo Chang; Benjamin Davidson; Warren M Grill; Marwan I Hariz; Andreas Horn; Michael Schulder; Antonios Mammis; Peter A Tass; Jens Volkmann; Andres M Lozano Journal: Nat Rev Neurol Date: 2020-11-26 Impact factor: 42.937